Li_2025_Medicine.(Baltimore)_104_e43922

Traumatic spinal cord injury (TSCI) involves dynamic pathophysiological processes, including primary mechanical damage and secondary inflammatory cascades. Early biomarkers to assess injury severity and predict recovery remain limited. To evaluate serum cholinesterase (ChE) as a biomarker for neurological outcomes in TSCI patients. In this retrospective cohort study, 80 cervical TSCI patients (stratified by ASIA impairment scale [AIS]: groups A-D) and 60 healthy controls were analyzed. Serum ChE levels were measured on days 1, 7, and 14 post-injury. Clinical outcomes and correlations between ChE levels and neurological recovery were assessed using analysis of variance, ^2 tests, and Spearman's analysis. ChE levels did not differ across groups at day 1. By days 7 and 14, ChE levels significantly decreased in all TSCI groups compared to controls (P<.05). Severe injury groups (AIS A/B) exhibited lower ChE levels than milder groups (AIS C/D) at both timepoints (P<.05). Lower baseline ChE correlated with poorer neurological recovery and stronger associations with inflammatory/oxidative stress markers. Serum ChE levels inversely correlate with TSCI severity and predict long-term neurological outcomes, highlighting its potential as a prognostic biomarker.